title: A youth-focused case management intervention to engage and retain young gay men of color in HIV care.
abstract: HIV-positive Latino and African-American young men who have sex with men (YMSM) have low rates of engagement and retention in HIV care. An evaluation of a youth-focused case management intervention (YCM) designed to improve retention in HIV care is presented. HIV-positive Latino and African-American YMSM, ages 18-24, who were newly diagnosed with HIV or in intermittent HIV care, were enrolled into a psychosocial case management intervention administered by Bachelor-level peer case managers at two HIV clinics in Los Angeles County, California. Participants met weekly with a case manager for the first two months and monthly for the next 22 months. Retention in HIV primary care at three and six months of follow-up was evaluated as were factors associated with retention in care. From April 2006 to April 2009, 61 HIV-positive participants were enrolled into the intervention (54% African-American, 46% Latino; mean age 21 years). At the time of enrollment into the intervention, 78% of the YMSM had a critical or immediate need for stable housing, nutrition support, substance abuse treatment, or mental health services. Among intervention participants (n=61), 90% were retained in primary HIV care at three months and 70% at six months. Among those who had previously been in intermittent care (n=33), the proportion attending all HIV primary care visits in the previous six months increased from 7% to 73% following participation in the intervention (p<0.0001). Retention in HIV care at six months was associated with increased number of intervention visits (p=0.05), more hours in the intervention (p=0.02), and prescription of HAART. These data highlight the critical needs of HIV-positive African-American and Latino YMSM and demonstrate that a clinic-based YCM can be effective in stabilizing hard-to-reach clients and retaining them in consistent HIV care.
authors.affiliation: Los Angeles County Department of Public Health, HIV Epidemiology Program, CA, USA. awohl@ph.lacounty.gov
authors.forename: Amy Rock
authors.initials: AR
authors.lastname: Wohl
authors.forename: Wendy H
authors.initials: WH
authors.lastname: Garland
authors.forename: Juhua
authors.initials: J
authors.lastname: Wu
authors.forename: Chi-Wai
authors.initials: CW
authors.lastname: Au
authors.forename: Angela
authors.initials: A
authors.lastname: Boger
authors.forename: Rhodri
authors.initials: R
authors.lastname: Dierst-Davies
authors.forename: Judy
authors.initials: J
authors.lastname: Carter
authors.forename: Felix
authors.initials: F
authors.lastname: Carpio
authors.forename: Wilbert
authors.initials: W
authors.lastname: Jordan
mesh_terms: D000293:Adolescent; D001741:Black or African American; D019090:Case Management / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D055815:Young Adult; D016903:Drug Monitoring